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Trauma Flashcards

0
Q

Causes of shock

A

Bleeding (hypovolemic hemorrhagic)-CVP low, empty veins
pericardial tamponade- CVP high, distended veins, trauma, no respiratory distress
Tension pneumothorax- CVP high, distended veins, trauma, respiratory distress, unilateral no breath sounds, hyperresonance, tracheal displacement.

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1
Q

Clinical signs of shock

A 
Low BP (<0.5mL/kg/h
Cold, shivering, sweating, thirsty, and apprehensive
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2
Q

Treatment of hemorrhagic shock

A

Volume replacement-2L LR w/ packed RBCs until 0.5 UOP

Surgery to stop bleeding

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3
Q

Management of pericardial tamponade

A

Clinical dx confirm with u/s

Pericardialcentesis, tube, pericardial window, or thoracotomy

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4
Q

Management of tension pneumothorax

A

Clinical dx
Catheter into affected pleural space
Follow with chest tube connected to underwater seal

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5
Q

Other causes of hypovolemic shock

A

Burns
Peritonitis
Pancreatitis
Massive diarrhea

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6
Q

Intrinsic cardiogenic shock

A

Caused by massive myocardial damage- MI or myocarditis
Tx with circulatory support
NO fluids

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7
Q

Vasomotor shock

A

Anaphylactic rxn or high spinal transection
Circulatory collapse in pink warm patient
CVP low
Restore peripheral resistance

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8
Q

Linear skull fracture

A

Left alone if closed
Open req closure
Comminuted or depressed go to OR

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9
Q

Head trauma w/LOC

A

Always get CT looking for intracranial hematoma

If negative can go home with wakings

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10
Q

Basilar skull fracture

A 
Raccoon eyes
Rhinorrhea
Otorrhea
Ecchymosis behind ears 
Assess integrity if C spine w/ CT
nasal endotracheal intubation AVOIDED
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11
Q

Neurological damage from trauma

A

Initial blow
Hematoma- displace structures
Increased ICP

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12
Q

Acute epidural hematoma

A

Trauma, LOC, lucid interval, gradual lapse into coma
Fixed dilated pupil, contra lateral hemiparesis, decerebrate
CT shows biconvex lens shaped hematoma
Tx emergency craniotomy

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13
Q

Acute subdural hematoma

A

Same but worse trauma and more severe damage
Not fully awake or asymptomatic at any point
CT shows semilunar crescent shaped hematoma
If midline shift, can craniotomy but bad prognosis
Prevent ICP increase: monitoring, elevate HOB, hyperventilate to pCO2 35, avoid fluid overload, mannitol, furosemide
Sedation to decrease brain activity
Hypothermia to reduce oxygen demand

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14
Q

Diffuse axial injury

A

Severe trauma
Cat shows diffuse blurring of gray-white interface and multiple small punctuate hemorrhages
Without hematoma no surgery
Prevent increased ICP

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15
Q

Chronic subdural hematoma

A

Occurs in very old or severe alcoholics
Shrunken brain rattles around tearing venous sinus
Over days/weeks mental fxn declines
CT dx and surgical evacuation tx

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16
Q

Hypovolemic shock and intracranial bleed

A

CANNOT HAPPEN

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17
Q

Penetrating neck trauma

A

Surgical exploration if hematoma, deteriorating vital signs or esophageal/tracheal injury
Explore GSW of middle zine

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18
Q

Selective neck trauma approach

A

GSW upper zone: arteriography

GSW base of neck: arteriography, water soluble esophagogram, esophagoscopy, and bronchoscope

19
Q

Neck stab wounds

A

Upper and middle zones observed

20
Q

Severe blunt trauma to neck

A

C spine eval

CT best

21
Q

Hemisection, brown sequard

A

Clean cut injury
Paralysis and loss of proprioception distal to injury ipsilaterally
Loss of pain perception contralateral

22
Q

Anterior cord syndrome

A

Seen with burst fracture of vertebrae
Loss of motor fxn, pain, and temperature bilaterally
Preserves vibratory and positional sense

23
Q

Central cord syndrome

A

Elderly with forced hyperextension of neck- rear ended

Paralysis and burning pain upper extremities

24
Rib fracture
Can be deadly in elderly Pain->atelectasis->pneumonia Tx w/ nerve block and epidural catheter
25
Pneumothorax
Penetrating trauma or rib fx stab SOB, unilateral loss of breath sounds, hyperresonance Get CXR then place chest tube
26
Hemothorax
Penetrating wound or rib fx Dull to percussion CXR Evacuate with chest tube to prevent empyema Thorocotomy if systemic vessel bleed Surgery if >1500ml in chest tube on insertion, or >600ml over 6 h
27
Severe blunt chest trauma
Hidden injuries Monitor blood gas and CXR for pulmonary contusion Cardiac enzymes and EKG for myocardial contusion Always look for traumatic aortic transection
28
Sucking chest wound
Flap sucks air Lead to tension pneumothorax Tx occlusive dressing
29
Flail chest
Multiple rib fx allows wall segment to cave in and bulge out Underlying pulmonary contusion Contusion sensitive to fluids so restriction and diuresis Monitor blood gas If ventilated, need bilateral chest tubes R/o aortic transection
30
Pulmonary contusion
Deteriorating blood gasses and white out of lungs on CXR can appear early or late Tx fluid restriction and diuresis
31
Myocardial contusion
Suspected in stern all fx EKG detects and cardiac enzymes Tx complications like arrhythmia
32
Traumatic rupture of diaphragm
Bowel in chest on exam and CXR Always on left side Eval with laparoscopy with surgical repair
33
Traumatic rupture if aorta
Occurs at junction of arch and descending Deceleration injury Asymptomatic until hematoma I'm adventitia blows up and kills Always suspicious esp if broken 1st rib, scapula or sternum; wide mediastinum Transesophageal echo, spiral CT, MRI angio
34
Traumatic rupture of trachea or bronchus
Subcutaneous emphysema in upper chest, lower neck, or air leak CXR shows air in tissue, bronchoscope shows lesion and allows intubation beyond lesion Surgical repair
35
Air embolism
Sudden death in chest trauma intubated on respirator Also when subclavian vein open to air Tx: cardiac massage w/ pt LT side down Prevent w/ trendelenburg when entering great vessels
36
Fat embolism
Respiratory distress Multiple fx including long bones Petechial rash in axilla and neck, fever, tachycardia, low platelets Tx w/ respiratory support
37
GSW to abdomen
Exploratory laparotomy | Enter or exit below nipple assumed abdominal
38
Abdominal stab wound
If clear penetration, unstable vitals, or peritoneal irritation then laparotomy Otherwise digital exploration of wound
39
Blunt trauma to abdomen
ExLap if signs of peritoneal irritation Otherwise determine if bleeding Look for signs of internal bleeding
40
Signs of internal bleeding in blunt trauma patient
Drop on BP w fast threads pulse, low CVP, and low, UOP Signs of shock when loss 25-30% blood volume Can be into pericardial sac, pleural cavity, abdomen, thighs and pelvis
41
Diagnosis of intraabdominal bleeding
CT scan only if hemodynamically stable Response to fluid resuscitation determines surgery If unstable, diagnostic peritoneal lavage or FAST
42
Ruptured Spleen
Most common significant intraabdominal bleed in blunt trauma Hints: fx LT rib Every effort made to salvage If removed, vaccinate pneumococcus, H. Influenza, and meningococcus
43
Intraoperative coagulopathy
Long abdominal surgery for multi trauma and lots of transfusions Tx w/ platelet packs and FFP 10 units each If also hypothermia and acidosis then stop lap and temporary close until correct issues
44
Abdominal compartment syndrome
Lots of fluids/blood in long laparotomy Tissues swollen and closure without tension impossible Temporary cover over contents then close later If you close anyway, get distention, retention sutures cutting thru tissue, hypoxia b/c can't breathe and renal failure from vena cava compression Then abdomen must be opened and put temporary cover

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